LPN to ADN Bridge Week 7 Quiz: Med-Surg Integration & Clinical
Judgment 2026/2027 UPDATE
1. A client presents with a pH of 7.28, PaCO2 of 52 mmHg, and HCO3 of 24
mEq/L. Which acid-base imbalance is the client experiencing?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Answer: B
Rationale: A pH below 7.35 indicates acidosis, and a PaCO2 above 45 mmHg indicates the
cause is respiratory.
2. Which assessment finding in a patient with chronic obstructive pulmonary
disease (COPD) requires immediate intervention by the nurse?
A. Oxygen saturation of 89% on room air
B. Presence of a barrel chest
C. A new onset of confusion and lethargy
D. Use of accessory muscles to breathe
Answer: C
Rationale: New onset confusion or lethargy in COPD patients may indicate CO2 narcosis or
severe hypoxia, requiring urgent evaluation.
,3. The nurse is prioritizing care for four patients. Which patient should the nurse
assess first?
A. A patient with a history of HF reporting a 2-pound weight gain in 3 days
B. A patient with asthma reporting a persistent non-productive cough
C. A patient with diabetes whose blood glucose is 160 mg/dL
D. A patient 2 hours post-op thyroidectomy reporting tingling around the mouth
Answer: D
Rationale: Perioral tingling after thyroidectomy is a sign of hypocalcemia
(Trousseau/Chvostek risk), which can lead to laryngospasm and airway obstruction.
4. Which laboratory value is most critical to report for a patient receiving
digoxin for heart failure?
A. Sodium 136 mEq/L
B. Potassium 3.0 mEq/L
C. Calcium 9.5 mg/dL
D. Magnesium 2.0 mEq/L
Answer: B
Rationale: Hypokalemia increases the risk of digoxin toxicity, which can lead to fatal
arrhythmias.
5. A patient with a deep vein thrombosis (DVT) suddenly develops dyspnea and
chest pain. What is the nurse’s priority action?
A. Obtain an EKG
B. Administer the scheduled heparin dose
C. Elevate the head of the bed and apply oxygen
D. Call the physician to request a chest X-ray
Answer: C
Rationale: Symptoms suggest pulmonary embolism. Elevating the head of the bed and
providing oxygen addresses immediate airway and gas exchange needs.
, 6. The nurse is caring for a patient in the oliguric phase of acute kidney injury
(AKI). Which dietary restriction should the nurse anticipate?
A. Restricted Carbohydrates
B. Increased fluid intake
C. Increased Sodium intake
D. Restricted Potassium and Protein
Answer: D
Rationale: In AKI, the kidneys cannot excrete potassium or nitrogenous waste effectively,
requiring restrictions to prevent hyperkalemia and azotemia.
7. When delegating to an Unlicensed Assistive Personnel (UAP), which task is
appropriate for the nurse to assign?
A. Checking the skin integrity of a patient with a pressure ulcer
B. Titrating oxygen flow for a patient with shortness of breath
C. Teaching a patient how to use an incentive spirometer
D. Feeding a patient who had a stroke 2 days ago and has no dysphagia
Answer: D
Rationale: UAPs can perform stable tasks like feeding if there is no high risk of aspiration.
Assessment, teaching, and titration require RN judgment.
8. A client is scheduled for a cholecystectomy. Which finding would cause the
nurse to contact the surgeon immediately?
A. The client reports a fear of surgery
B. The client has a history of smoking
C. The white blood cell count is 10,000/mm3
D. The client ate a light snack 2 hours ago
Answer: D
Rationale: The client must be NPO for several hours before surgery to prevent aspiration
during anesthesia.
Judgment 2026/2027 UPDATE
1. A client presents with a pH of 7.28, PaCO2 of 52 mmHg, and HCO3 of 24
mEq/L. Which acid-base imbalance is the client experiencing?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Answer: B
Rationale: A pH below 7.35 indicates acidosis, and a PaCO2 above 45 mmHg indicates the
cause is respiratory.
2. Which assessment finding in a patient with chronic obstructive pulmonary
disease (COPD) requires immediate intervention by the nurse?
A. Oxygen saturation of 89% on room air
B. Presence of a barrel chest
C. A new onset of confusion and lethargy
D. Use of accessory muscles to breathe
Answer: C
Rationale: New onset confusion or lethargy in COPD patients may indicate CO2 narcosis or
severe hypoxia, requiring urgent evaluation.
,3. The nurse is prioritizing care for four patients. Which patient should the nurse
assess first?
A. A patient with a history of HF reporting a 2-pound weight gain in 3 days
B. A patient with asthma reporting a persistent non-productive cough
C. A patient with diabetes whose blood glucose is 160 mg/dL
D. A patient 2 hours post-op thyroidectomy reporting tingling around the mouth
Answer: D
Rationale: Perioral tingling after thyroidectomy is a sign of hypocalcemia
(Trousseau/Chvostek risk), which can lead to laryngospasm and airway obstruction.
4. Which laboratory value is most critical to report for a patient receiving
digoxin for heart failure?
A. Sodium 136 mEq/L
B. Potassium 3.0 mEq/L
C. Calcium 9.5 mg/dL
D. Magnesium 2.0 mEq/L
Answer: B
Rationale: Hypokalemia increases the risk of digoxin toxicity, which can lead to fatal
arrhythmias.
5. A patient with a deep vein thrombosis (DVT) suddenly develops dyspnea and
chest pain. What is the nurse’s priority action?
A. Obtain an EKG
B. Administer the scheduled heparin dose
C. Elevate the head of the bed and apply oxygen
D. Call the physician to request a chest X-ray
Answer: C
Rationale: Symptoms suggest pulmonary embolism. Elevating the head of the bed and
providing oxygen addresses immediate airway and gas exchange needs.
, 6. The nurse is caring for a patient in the oliguric phase of acute kidney injury
(AKI). Which dietary restriction should the nurse anticipate?
A. Restricted Carbohydrates
B. Increased fluid intake
C. Increased Sodium intake
D. Restricted Potassium and Protein
Answer: D
Rationale: In AKI, the kidneys cannot excrete potassium or nitrogenous waste effectively,
requiring restrictions to prevent hyperkalemia and azotemia.
7. When delegating to an Unlicensed Assistive Personnel (UAP), which task is
appropriate for the nurse to assign?
A. Checking the skin integrity of a patient with a pressure ulcer
B. Titrating oxygen flow for a patient with shortness of breath
C. Teaching a patient how to use an incentive spirometer
D. Feeding a patient who had a stroke 2 days ago and has no dysphagia
Answer: D
Rationale: UAPs can perform stable tasks like feeding if there is no high risk of aspiration.
Assessment, teaching, and titration require RN judgment.
8. A client is scheduled for a cholecystectomy. Which finding would cause the
nurse to contact the surgeon immediately?
A. The client reports a fear of surgery
B. The client has a history of smoking
C. The white blood cell count is 10,000/mm3
D. The client ate a light snack 2 hours ago
Answer: D
Rationale: The client must be NPO for several hours before surgery to prevent aspiration
during anesthesia.
